Bone graft placement device

ABSTRACT

A surgical assembly includes a first guidewire and a second guidewire, in which each of the first guidewire and the second guidewire are configured to be received by a bone block, a first suture loop, a second suture loop, a first locking component, and a second locking component, in which the first locking component is coupled to the first suture loop and the second locking component is coupled to the second suture loop. The locking component has a hole formed therethrough, in which the hole of the locking component is configured to receive the suture, and may be tethered to a suture by knots engaging a counterbore at opposed ends of a bore defined by the hole.

CROSS REFERENCE TO RELATED APPLICATION

This application is a divisional of U.S. patent application Ser. No.13/606,886 filed Sep. 7, 2012 entitled BONE GRAFT PLACEMENT DEVICE,which is a Continuation in Part of U.S. patent application Ser. No.13/188,254 filed Jul. 21, 2011, entitled IMPLANT RETAINING LOOP ANDGUIDE WIRE EXTENSION now U.S. Pat. No. 9,320,557 and claims the benefitof U.S. Provisional Patent Application No. 61/532,432 filed Sep. 8,2011, entitled SUTURE LOOP WITH SST BALL, the contents of which areincorporated by reference herein in their entirety for all purposes.

BACKGROUND

The etiology of anterior-inferior glenohumeral instability ismultifactorial. Avulsion fractures of the anterior fractures of theanterior glenoid rim, so-called bony Bankart lesions, are associatedwith anterior-inferior glenohumeral instability. Successful treatment ofthis condition requires a surgical approach that allows relevantlesions, which may cause shoulder instability, to be identified andrepaired.

Presently, anterior-inferior shoulder instability associated withlesions in soft tissue can be successfully treated arthroscopically, andthe clinical outcomes may be generally similar to those found after anopen procedure. However, the major risk of recurrent instability afteran arthroscopic procedure, when compared to an open procedure, isrelated to the presence of additional bony defects of the glenoid. Apresent method of bony Bankart repair, or treating anterior-inferiorglenohumeral instability, involves pushing/pulling a bone block withgraspers within the body and securing the bone block with a suture andscrews. Manipulating the bone block within the body using graspers andsecuring the bone block within the body using sutures may be difficult,and as a result, time-consuming, for a surgeon.

Accordingly, there exists a need for an improved technique for treatinganterior-inferior glenohumeral instability.

SUMMARY

According to one aspect of the present invention, there is provided asurgical assembly, the assembly including a first guidewire, a secondguidewire, in which each of the first guidewire and the second guidewireare configured to be received by a bone block, a first suture loop, asecond suture loop, a first locking component, and a second lockingcomponent, in which the first locking component is coupled to the firstsuture loop and the second locking component is coupled to the secondsuture loop.

According to another aspect of the present invention, there is provideda surgical method, the method including forming a posterior portal in abody, forming an anterior portal in the body, inserting a firstguidewire and a second guidewire into the posterior portal, pulling eachof the first guidewire and the second guidewire out of the body, throughthe anterior portal, disposing each of the first guidewire and thesecond guidewire through a bone block, securing a first suture loop tothe first guidewire and a second suture loop to the second guidewire,disposing the bone block into the body with the first guidewire and thesecond guidewire, through the anterior portal, removing each of thefirst suture loop and the second suture loop, and securing the boneblock within the body, against the glenoid.

According to another aspect of the present invention, there is provideda surgical kit, the kit including a first cannula having a hole formedtherethrough and configured to receive a bone block, a proximal end, adistal end, and a central axis is defined therethrough, a firstguidewire, a second guidewire, a first suture loop comprising a firstlocking member, and a second suture loop comprising a second lockingmember.

According to another aspect of the present invention, there is provideda method for forming a closed loop for a surgical delivery apparatus,the method including providing a suture and a locking component, thelocking component having a hole formed therethrough and is configured toreceive the suture, disposing a first end of the suture through the holeformed through the locking component in a first direction, disposing asecond end of the suture through the hole formed through the lockingcomponent in a second direction that is opposite to the first direction,forming a first knot on the suture with the first end of the suture, andforming a second knot on the suture with the second end of the suture.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of theinvention will be apparent from the following description of particularembodiments of the invention, as illustrated in the accompanyingdrawings in which like reference characters refer to the same partsthroughout the different views. The drawings are not necessarily toscale, emphasis instead being placed upon illustrating the principles ofthe invention.

FIG. 1 shows a perspective view of a surgical assembly according toembodiments disclosed herein;

FIGS. 2A-2F show multiple views of a surgical assembly according toembodiment disclosed herein;

FIGS. 3A-3R show a method of using a surgical assembly within a bodyaccording to embodiments disclosed herein;

FIGS. 4A-4L show an alternate configured having a suture loop 801 with alocking ball 802; and

FIGS. 5A-5D depict bone graft mounting using the locking ball 802arrangement of FIGS. 4A-4L.

DETAILED DESCRIPTION

The following is directed to various exemplary embodiments of thedisclosure. Although one or more of these embodiments may be preferred,the embodiments disclosed should not be interpreted, or otherwise used,as limiting the scope of the disclosure, including the claims. Inaddition, those having ordinary skill in the art will appreciate thatthe following description has broad application, and the discussion ofany embodiment is meant only to be exemplary of that embodiment, and notintended to suggest that the scope of the disclosure, including theclaims, is limited to that embodiment.

Certain terms are used throughout the following description and claimsrefer to particular features or components. As those having ordinaryskill in the art will appreciate, different persons may refer to thesame feature or component by different names. This document does notintend to distinguish between components or features that differ in namebut not function. The figures are not necessarily to scale. Certainfeatures and components herein may be shown exaggerated in scale or insomewhat schematic form and some details of conventional elements maynot be shown in interest of clarity and conciseness.

In the following discussion and in the claims, the terms “including” and“comprising” are used in an open-ended fashion, and thus should beinterpreted to mean “including, but not limited to . . . .” Also, theterm “couple” or “couples” is intended to mean either an indirect ordirect connection. Thus, if a first component is coupled to a secondcomponent, that connection may be through a direct connection, orthrough an indirect connection via other components, devices, andconnections. Further, the terms “axial” and “axially” generally meanalong or substantially parallel to a central or longitudinal axis, whilethe terms “radial” and radially” generally mean perpendicular to acentral, longitudinal axis.

Additionally, directional terms, such as “above,” “below,” “upper,”“lower,” etc., are used for convenience in referring to the accompanyingdrawings. In general, “above,” “upper,” “upward,” and similar termsrefer to a direction toward the earth's surface from below the surfacealong a borehole, and “below,” “lower,” “downward,” and similar termsrefer to a direction away from the surface along the borehole, i.e.,into the borehole, but is meant for illustrative purposes, only, and theterms are not meant to limit the disclosure.

Referring now to FIG. 1, a perspective view of a surgical assembly 100,in accordance with embodiments disclosed herein, is shown. In one ormore embodiments, the assembly 100 may include a first cannula 101, afirst guidewire 111, a second guidewire 112, a first suture loop 121, asecond suture loop 122, a first locking member 123, and a second lockingmember 124. As shown, each of the first guidewire 111 and the secondguidewire 112 are configured to be received by a bone block 110.Further, as shown, the first locking component 123 is coupled to thefirst suture loop 121 and the second locking component 124 is coupled tothe second suture loop 122.

In one or more embodiments, the first cannula 101 may include a hole 109formed therethrough, a proximal end 105, a distal end (not shown), and acentral axis 150 defined therethrough. In one or more embodiments, thehole 109 of the first cannula 101 may be configured to receive a boneblock/graft, e.g., the bone block 110. As will be discussed below, inone or more embodiments, the first guidewire 111 and the secondguidewire 112 may be used to reposition, or reorient, the bone block 110such that the bone block 110 may be disposed within the hole 109 of thefirst cannula 101 and displaced through the first cannula 101. Forexample, in one or more embodiments, the bone block 110 may berepositioned, or reoriented, by the first guidewire 111 and the secondguidewire 112 such that a longitudinal axis of the bone block 110 issubstantially parallel with the central axis 150 of the first cannula101. Further, the first guidewire 111 and the second guidewire 112 maybe used to move, or displace, the bone block 110 through the firstcannula 101, into a body (not shown).

In one or more embodiments, each of the first guidewire 111 and thesecond guidewire 112 may be formed from any substantially rigid materialor any flexible material known in the art. For example, each of thefirst guidewire 111 and the second guidewire 112 may be made of aplastic or a metal, such as Nitinol. Further, in one or moreembodiments, each of the first guidewire 111 and the second guidewire112 may be looped guidewires. In other words, in one or moreembodiments, the first guidewire 111 may include a first loop 117 andthe second guidewire 112 may include a second loop 118. In one or moreembodiments, the first loop 117 of the first guidewire 111 and thesecond loop 118 of the second guidewire 112 may be configured to receivesuture loops 121, 122, respectively. Although FIG. 1 shows an embodimentof the surgical assembly 100 with only two guidewires 111, 112 thosehaving ordinary skill in the art will appreciate that more or less thantwo guidewires may be used. For example, in one or more embodiments,one, three, four or more guidewires may be used.

In one or more embodiments, the first suture loop 121 may be configuredto be secured to the first guidewire 111 and the second suture loop 122may be configured to be secured to the second guide wire 112. Forexample, as shown, the first suture loop 121 is configured to be securedto the first loop 117 of the first guidewire 111 and the second sutureloop 122 is configured to be secured to the second loop 118 of thesecond guidewire 112. As will be discussed below, in one or moreembodiments, the first suture loop 121 may be displaced, looped orpassed, through the first loop 117 of the first guidewire 111, and alsodisplaced, looped or passed, back through itself in order to secure thefirst suture loop 121 and the first locking member 123 to the first loop117 of the first guidewire 111. Similarly, the second suture loop 122may be displayed, looped or passed, through the second loop 118 of thesecond guidewire 112, and also displaced, looped or passed, back throughitself in order to secure the second suture loop 122 and the secondlocking member 124 to the second loop 118 of the second guidewire 112.In one or more embodiments, in order to remove, or disengage, each ofthe first suture loop 121 and the second suture loop 122 from the firstguidewire 111 and the second guidewire 112, respectively, a surgeon maypull each of the first locking member 123 and the second locking member124 in a direction that is substantially away from each of theguidewires 111, 112. Pulling each of the first locking member 123 andthe second locking member 124 in a direction that is substantially awayfrom each of the guidewires, 111, 112 may cause each of the suture loops121, 122 to become unraveled, or become un-looped, and disengaged fromeach of the guidewires 111, 112.

Further, in one or more embodiments, each of the first suture loop 121and the second suture loop 122 may be formed from any flexible materialknown in the art, such as suture, plastic, or a malleable metal, such asNitinol. Alternatively, carrying arrangements of holes for suture loopsmay be employed, such as one or multiple (3 or more) suture loops may beemployed. In one or more embodiments, each of the first suture loop 121and the second suture loop 122 may be closed, continuous loop.Alternatively, in one or more embodiments, each of the first suture loop121 and the second suture loop 122 may be closed and may contain a knot(not shown).

As discussed above, in one or more embodiments, the first lockingcomponent 123 may be coupled to the first suture loop 121 and the secondlocking component 124 may be coupled to the second suture loop 122.Those having ordinary skill in the art will appreciate that the firstlocking component 123 and the second locking component 124 may becoupled to the first suture loop 121 and the second suture loop 122,respectively, by mechanical or chemical means, such as crimping,molding, or gluing. Alternatively, in one or more embodiments, each ofthe first locking component 123 and the second locking component 124 mayinclude a hole formed therethrough, in which each of the first lockingcomponent 123 and the second locking component 124 may be threaded ontothe first suture loop 121 and the second suture loop 122, respectively,e.g., a bead on a necklace. As shown, each of the first lockingcomponent 123 and the second locking component 124 is substantiallyspherical in shape. Those having ordinary skill in the art willappreciate that the shape of the first locking component and the secondlocking component 124 may be any shape known in the art. For example,the shape of each of the first locking component 123 and the secondlocking component 124 may be spherical, hemi-spherical, cubic,prismatic, pyramidal, or any other shape known in the art. Further, eachof the first locking component 123 and the second locking component 124may be formed from any material known in the art. For example, in one ormore embodiments, each of the first locking component 123 and the secondlocking component 124 may be formed from metal, plastic, ceramic, or anyother material known in the art. Alternatively, each of the firstlocking component 123 and the second locking component 124 may be formedfrom any biocompatible and/or bioabsorbable material known in the art.

Referring to FIGS. 2A-2F, multiple views of a surgical assembly 200, inaccordance with embodiments disclosed herein, are shown. In one or moreembodiments, the assembly 200 may include a first cannula 201, a firstguidewire 211, a second guidewire 212, a first suture loop 221, a secondsuture loop 222, a first locking member 223, and a second locking member224.

As shown in FIG. 2A, the first cannula 201 includes a hole 209 formedtherethrough, a proximal end 205, a distal end (not shown), and acentral axis 250 defined therethrough is shown. In one or moreembodiments, each of the first guidewire 211 and the second guidewire212 may be disposed within, or inserted into, the first cannula 201through an end of the first cannula, e.g., the distal end, and displacedthrough the first cannula 201, and may exit through the proximal end 205of the first cannula 201. As discussed above, each of the firstguidewire 211 and the second guidewire 212 may be formed from anysubstantially rigid material or any flexible material known in the art.For example, each of the first guidewire 211 and the second guidewire212 may be made of a plastic or a metal, such a Nitinol. Further, in oneor more embodiments, each of the first guidewire 211 and the secondguidewire 212 may be looped guidewires. In other words, as shown, thefirst guidewire 211 may include a first loop 217 and the secondguidewire 212 may include a second loop 218.

As shown in FIG. 2B, the first guidewire 211 may be disposed through thefirst cannula 201 and through a bone block 210. As shown, the bone block210 includes two holes 219A, 219B, which are configured to receive thefirst guidewire 211 and the second guidewire 212, respectively. Thosehaving ordinary skill in the art will appreciate that the bone block 210may be any bone block or bone graft that may be used in a surgicalprocedure. For example, in one or more embodiments, the bone block 210may be used to treat anterior inferior glenohumeral instability within abody. Alternatively, the bone block 210 may be a bone block or bonegraft of an appropriate size and shape, e.g., of appropriate dimensions,that may be used in a surgical procedure involving the shoulder, hip,knee, wrist, or ankle in a body, such as a labrum repair.

As shown in FIG. 2C, once the first guidewire 211 has been disposedthrough the bone block 210, the first suture 221 may be displaced,looped or passed, through the first loop 217 of the first guidewire 211.Further, as shown, the first locking component 223 is coupled to thefirst suture loop 221. As discussed above, in one or more embodiments,the first locking component 223 may be coupled to the first suture loop221. Those having ordinary skill in the art will appreciate that thefirst locking component 223 may be coupled to the first suture loop 221,by any means known in the art. For example, the first locking componentmay be coupled to the first suture loop by suitable mechanical orchemical means, such as crimping, molding, welding or gluing.Alternatively, in one or more embodiments, the first locking component223 may include a hole formed therethrough, in which the first lockingcomponent 223 may be threaded on the first suture loop 221, e.g., a beadon a necklace.

As shown in FIG. 2D, the first suture loop 221 may be also displaced,looped or passed, back through itself, e.g., in the direction of arrowP, in order to secure the first suture loop 221 and the first lockingmember 223 to the first loop 217 of the first guidewire 211. Asdiscussed above, in one or more embodiments, the first suture loop 221may be formed from any flexible material known in the art, such assuture, plastic, or a malleable metal, such as Nitinol. In one or moreembodiments, the first suture loop 221 may be closed and may contain aknot (not shown).

As shown in FIG. 2E, once the first suture loop 221 is displaced, loopedor passed, through the first loop 217 of the first guidewire 211 andalso displaced, looped or passed, back through itself, the first suture221 may be tensioned, e.g., substantially in the direction of the arrowP of FIG. 2D, to secure the first suture loop 221 and the first lockingmember 223 to the first guidewire 211. Those having ordinary skill inthe art will appreciate that the first suture loop 221 may be secured tothe first guidewire 211 by other methods known in the art, other thanwhat is described above. For example, the first suture loop 221 may betied in a knot to the first guidewire 211. Alternatively, the firstsuture loop 221 may be displaced, looped or passed, through the firstloop 217 of the first guidewire 211, and an end of the first suture loop221 may be wrapped, or twisted, around an opposite end of the firstsuture loop 221 in order to secure the first suture loop 221 to thefirst guidewire 211. Further, as discussed above, in one or moreembodiments, in order to remove, or disengage, the first suture loop 221from the first guidewire 211, a surgeon may pull the first lockingmember 223 in a direction that is substantially away from the firstguidewire 211. Pulling the first locking member 223 in a direction thatis substantially away from the first guidewire 211 may cause the firstsuture loop 221 to become unraveled, or become un-looped, and disengagedfrom the first guidewire 211.

Referring now to FIG. 2F, a perspective view of the assembly 200, inaccordance with embodiments disclosed herein, is shown. As shown, thesame procedure, shown and described above in FIGS. 2B-2E with regard tothe first guidewire 211 and the first suture loop 221, may be applied tothe second guidewire 212 and the second suture loop 222. For example, inone or more embodiments, the second guidewire 212 may be disposedthrough the hole 219B of the bone block 210. Further, in one or moreembodiments, the second suture loop 222 may be displaced, looped orpassed, through the second loop 218 of the second guidewire 212.Furthermore, in one or more embodiments, the second suture loop 222 maybe also displaced, looped or passed, back through itself, e.g., in thedirection of the arrow P of FIG. 2D, in order to secure the secondsuture loop 222 and the second locking member 224 to the second loop 218of the second guidewire 212 and also displaced, looped or passed, backthrough itself, the second suture loop 222 may be tensioned, e.g.,substantially in the direction of the arrow P of FIG. 2D, to secure thesecond suture loop 222 and the second locking member 224 to the secondguidewire 212. As discussed above, the bone block 210 may berepositioned, or reoriented, by the first guidewire 211 and the secondguidewire 212 such that a longitudinal axis of the bone block 210 issubstantially parallel with the central axis 250 of the first cannula.Further, the first guidewire 211 and the second guidewire 212 may beused to move, or displace, the bone block 210 through the first cannula201.

A surgical method, in accordance with embodiments disclosed herein, mayinclude forming a posterior portal in the body, forming an anteriorportal in the body, inserting a first guidewire and a second guidewireinto the posterior portal, pulling each of the first guidewire and thesecond guidewire out of the body, through the anterior portal, disposingeach of the first guidewire and the second guidewire through a boneblock, securing a first suture loop to the first guidewire and a secondsuture loop to the second guidewire, disposing the bone block into thebody with the first guidewire and the second guidewire, through theanterior portal, removing each of the first suture loop and the secondsuture loop, and securing the bone block within the body, against theglenoid.

In one or more embodiments, disposing the bone block into the body mayinclude orienting the bone block such that a longitudinal axis of thebone block is substantially parallel to the central axis of the firstcannula. In one or more embodiments, pulling each of the first guidewireand the second guidewire out of the body may include using a grasper topull each of the first guidewire and the second guidewire out of thebody, through the anterior portal. Further, in one or more embodiments,disposing the bone block into the body may include pushing the boneblock into the body, through the first cannula, with an obturator. Inone or more embodiments, disposing the bone block into the body mayinclude pulling the bone block into the body, through the first cannula,with each of the first guidewire and the second guidewire. Furthermore,in one or more embodiments, securing the bone block within the bodycomprises securing at least one threaded screw through the bone block,into the glenoid.

The method may also include disposing a guide comprising a hook into thebody, through the posterior portal, positioning the hook of the guide onan anterior side of the glenoid, forming a first hole and a second holethrough the glenoid, from the posterior side of the glenoid to theanterior side of the glenoid, inserting a first cannula into the body,through the anterior portal, the first cannula comprising a hole formedtherethrough, a proximal end, a distal end, and a central axis definedtherethrough, and removing each of the first guidewire and the secondguidewire from the body.

For example, referring now to FIGS. 3A-3R, a surgical method, inaccordance with embodiments disclosed herein, is shown. In one or moreembodiments, a surgical assembly 300 may include a first cannula 301, afirst guidewire 311, a second guidewire 312, a first suture loop 321, asecond suture loop 322, a first locking member 323, and a second lockingmember 324.

Referring to FIG. 3A, a spinal needle (not shown) may be inserted from aposterior side of a glenoid 340 to an anterior side of the glenoid 340,along a face of the glenoid 340. According to one or more aspects, thespinal needle may be positioned below an equator (not shown) of theglenoid 340 and may be used to confirm placement of a posteriorinstrument portal (not shown). Once the posterior instrument portal isformed, a hooked end 331 of a glenoid guide 330 may be disposed within,or inserted through, the posterior instrument portal. The hooked 331 ofthe glenoid guide 330 may be passed across the glenoid 340 and over ananterior edge 341 of the glenoid 340, substantially parallel to theglenoid face in order to avoid damaging the articular surface. Theglenoid guide 330 may be rotated such that the hooked end 331 of theglenoid guide 330 may engage the anterior edge 341 of the glenoid 340.The hooked end 331 of the glenoid guide 330 may be placed at the 4o'clock position and may correlate with a midpoint of a bone block (notshown). However, those having ordinary skill in the art will appreciatethat the hooked end 331 of the glenoid guide 330 may be placed at anyposition on the glenoid 340. For example, the hooked end 331 of theglenoid 330 may be placed at the 2 o'clock position and may correlatedwith the midpoint of the bone block.

Referring to FIG. 3B, once the hooked end is positioned, a first guide333 may be placed in a superior hole (not shown) of the glenoid guide330. A skin incision may be made and the first guide 333 may be advancedinto the body until the first guide 333 engages a posterior side of theglenoid 340. The first guide 333 may include ratchet teeth 337, orthreads, that may engage with corresponding ratchet threads, or threads,of the glenoid guide 330. According to one or more aspects, the firstguide 33 may be advanced, displaced, and/or secured into the body, alongthe glenoid guide 330 using the ratchet teeth 337. Similarly, a secondguide 334 may also be disposed into the body and may also engage aposterior side of the glenoid 340. According to one or more aspects, thesecond guide 334 may be placed in an inferior hole (not shown) of theglenoid guide 330. Further, a first sleeve (not shown) and a secondsleeve (not shown) may be disposed within the first guide 333 and thesecond guide 334, respectively, and may be engaged with the posteriorside of the glenoid 340.

Referring to FIGS. 3C and 3D, a first hole 349A and a second hole 349Bmay be formed through the glenoid, from the posterior side of theglenoid 340 to the anterior side 341 of the glenoid 340. According toone or more aspects, a drill (not shown) may be disposed within each ofthe first guide 333 and the second guide 334, shown in FIG. 3B, and maybe advanced under power until the drill bit, e.g., drill bits 344A,344B, exits the anterior edge/side 341 of the glenoid 340. As shown, thehooked end 331 of the glenoid guide (not shown) may provide a force inthe posterior direction, i.e., in the direction of arrow W, while thedrill bits 344A, 344B may be advanced in the anterior direction, i.e.,in a direction that is opposite to the arrow W. According to one or moreaspects, a 2.8 mm drill may be used to form the first hole 349A and thesecond hole 349B. However, those having ordinary skill in the art willappreciate that any size drill may be used to form the first hole 349Aand the second hole 349B. According to one or more aspects, each of thefirst hole 349A and the second hole 349B may be 5 mm on center below acortical edge of the glenoid face, and the holes 349A, 349B formed bythe drill may be parallel to one another, and may be 10 mm apart, centerto center. However, those having ordinary skill in the art willappreciate that the holes 349A, 349B may be more or less than 10 mmapart, center to center. Furthermore, those having ordinary skill in theart will appreciate that more or less than two holes, e.g., the firsthole 349A and the second hole 349B, may be formed in the glenoid 340.For example, according to one or more aspects, one hole, or three holes,may be formed in glenoid 340, exiting the anterior side 341 of theglenoid 340.

Referring to FIG. 3E, according to one or more aspects, once forming theholes 349A, 349B is complete, the drill (not shown) may be removed fromeach of the guides (not shown), e.g., the guide 333, 334 of FIG. 3B,leaving the a first sleeve 335 and a second sleeve 336 in place withinthe body, engaged with the posterior side of the glenoid 340, and maycorrespond to the holes 349A, 349B formed on the anterior side/edge 341of the glenoid 340. Further, the glenoid guide (not shown) may beremoved. According to one or more aspects, a 1 mm pin may be disposedwithin each of the sleeves 335, 336 to ensure that the sleeves 335, 336are free from debris. Those having ordinary skill in the art willappreciate that a member of any diameter, smaller or larger than 1 mmthat is configured to be received by the sleeves 335, 336 may be used toremove debris from the sleeves 335, 336 and to ensure that each ofsleeves 335, 336 is free from debris.

Referring to FIG. 3F, a first guidewire 311 and a second guidewire (notshown) may be disposed, or inserted, into the posterior portal, throughthe sleeves (not shown), e.g. the first sleeve 335 and the second sleeve336 of FIG. 3E, respectively, and into the body. Further, an anteriorportal (not shown) may be formed, and a first cannula 301 may bedisposed, or inserted, into the body through the anterior portal. Asshown, the first guidewire 311 may be disposed through the first sleeveand through the first hole 349A formed through the anterior side/edge341 of the glenoid 340. Further, as shown, a grasper 360 may disposedinto a proximal end (not shown) of the first cannula 301, may exit thefirst cannula at a distal end 306 of the first cannula 301, and may beused to engage, or retrieve, the first guidewire 311. According to oneor more aspects, the grasper 360 may be used to pull each of the firstguidewire 311 and the second guidewire out of the body, through theanterior portal, through the first cannula 301.

Referring to FIG. 3G, a bone block 310, according to embodimentsdisclosed herein, is shown. As shown, the bone block 310 may include afirst hole 319A and a second hole 319B. As discussed above, each of theholes 319A, 319B may be configured to receive a first guidewire (notshown) and a second guide wire (not shown). Further, as discussed above,those having ordinary skill in the art will appreciate that the boneblock 310 may be any bone block or bone graft that may be used in asurgical procedure. For example, in one or more embodiments, the boneblock 310 may be used to treat anterior inferior glenohumeralinstability within a body. Alternatively, the bone block 310 may be abone block or bone graft of an appropriate size and shape, e.g. ofappropriate dimensions, that may be used in a surgical procedureinvolving the shoulder, hip, knee, wrist, or ankle in a body. Forexample, according to one or more aspects, a tri cortical iliac crestbone block, measuring 20 mm×8 mm×8 mm may be harvested and fashionedusing a graft preparation board. Further, according to one or moreaspects, the holes 319A, 319B may be 2.8 mm in diameter and may be 10 mmapart, center or center. A drill may be used to form the holes 319A,319B by entering through the cortex and exiting the cancellous side ofthe bone block 310. The holes 319A, 319B may be formed to correspondwith the sleeves (not shown), e.g., sleeves 335, 336 placed in theglenoid, shown in FIG. 3E, and/or may be formed to correspond with theholes 349A, 349B formed in the glenoid 340, also shown in FIG. 3E. Asdiscussed above, those having ordinary skill in the art will appreciatethat more or less than two guidewires, e.g. guidewires 311, 312, may beused. For example, in one or more embodiments, one, three, four or moreguidewires may be used. Accordingly, those having ordinary skill in theart will also appreciate more or less than two holes, e.g., holes 319A,319B, may be formed through the bone block 310. For example, in one ormore embodiments, one, three, four, or more holes may be formed throughthe bone block 310.

Referring to FIG. 3H, each of the guidewires 311, 312 may be pulledthrough the first cannula 301, exiting a proximal end 305 of the firstcannula 301. Further, each of the guidewires 311, 312 may be disposedthough each of the holes 319A, 319B of the bone block 310, respectively.According to one or more aspects, each of the guidewires 311, 312 may beinserted through the cancellous side of the bone block 310 and may exitthrough the cortical side of the bone block 310. According to one ormore aspects, at least a portion of the guidewires 311, 312 may remainoutside of the body, posteriorly, and may allow a surgeon to manipulateeach of the guidewires 311, 312 posteriorly, while at least a portion ofeach of the guidewires 311, 312 is disposed within the body and/or isoutside of the body on the anterior side.

Referring to FIGS. 3I and 3J, a first suture loop 312 having a firstlocking member 323 may be displaced, looped or passed, through the firstloop 317 of the first guidewire 311, and also displaced, looped orpassed, back through itself, in the direction or arrow D, in order tosecure the first suture loop 321 and the first locking member 323 to thefirst loop 317 of the first guidewire 311. Similarly, as shown in FIG.3J, the second suture loop 322 may be displaced, looped or passed,through the second loop 318 of the second guidewire 312, and alsodisplaced, looped or passed, back through itself in order to secure thesecond suture loop 322 and the second locking member 324 to the secondloop 319 of the second guidewire 312. Further, according to one or moreaspects, each of the first suture loop 321 and the second suture loop322 may be tensioned, e.g., in a direction substantially away from thefirst cannula 301, to secure the first suture loop 321 and the firstlocking member 323 to the first guidewire 311 and to secure the secondsuture loop 322 and the second locking member 324 to the secondguidewire 312. As shown, each of the first locking member 323 and thesecond locking member 324 is resting against the bone block 310.

Referring to FIGS. 3K and 3L, multiple views of the surgical assembly300, in accordance with embodiments disclosed herein, are shown. Asshown, the bone block 310 may be disposed within the first cannula 301,through the proximal end 305 of the first cannula, and may be advancedinto the body through the first cannula 301, through the anteriorportal. According to one or more aspects, disposing the bone block 310into the body may include pushing the bone block 310 into the body,through the first cannula 301, with an obturator 365. According to oneor more aspects, disposing the bone block 310 into the body may includepulling the bone block 310 into the body, through the first cannula 301,with each of the first guidewire 211 and the second guidewire 312.According to one or more aspects, the first guidewire 311 and the secondguidewire 312 may be used to reposition, or reorient, the bone block 310such that the bone block 310 may be disposed within the first cannula301 and displaced through the first cannula 301. For example, in one ormore embodiments, the bone block 310 may be repositioned, or reoriented,by the first guidewire 311 and the second guidewire 312 such that alongitudinal axis of the bone block 310 is substantially parallel with acentral axis 350 of the first cannula 301. Once the bone block 310 isfully inserted into the first cannula 301, the guide wires 311, 312exiting the body, e.g., the shoulder, posteriorly may be tensioned toremove any slack in the guide wires 311, 312. According to one or moreaspects, even if an obturator 365 is used to push the bone block 310into the body through the first cannula 301, slight tension may beapplied and/or maintained on the guidewires 311, 312, e.g., from theposterior side of the guidewires 311, 312.

As shown in FIG. 3L, the bone block 310 may exit the distal end 306 ofthe first cannula 301, inside the body, in a region of the body near theanterior edge/side 341 of the glenoid 340. As discussed above, in one ormore embodiments, the obturator (not shown) may be used to push the boneblock 310 into the body, toward the anterior edge/side 341 of theglenoid 340. Additionally, in one or more embodiments, the firstguidewire 311 and the second guidewire 312, disposed through the holes349A, 349B, respectively, may be used to apply and/or maintain slighttension on the bone block 310, as it is pushed into the body with theobturator. Alternatively, in one or more embodiments, the firstguidewire 311 and the second guidewire 312, disposed through the holes349A, 349B, respectively, may be used to pull the bone back 310 into thebody, toward the anterior edge/side 341 of the glenoid 340, without theuse of an obturator.

Referring to FIG. 3M, each of the guidewires (not shown), e.g.guidewires 311, 312 shown in FIG. 3L, disposed within sleeves 335, 336,may be pulled, or tensioned, posteriorly, and the bone block 310 mayexit the distal end 306 for the first cannula 301, and may bemanipulated, reoriented or repositioned, until it is placed in anintended position along the anterior neck of the glenoid 340. Accordingto one or more aspects, the cancellous portion of the bone block 310 maybe secured against the glenoid 340, e.g. a neck of the glenoid 340.Further, according to one or more aspects, a grasper (not shown), e.g.,the grasper 360 shown in FIG. 3F, may be used to manipulate, reorient orreposition, the bone block 310 within the body, against the glenoid 340.During the placement of the bone block 310 within the body, slighttension may be maintained on each of the suture loop 321, 322,anteriorly, such that each of the first locking member 323 and thesecond locking member 324 are engaged with the bone block 310, while theguidewires 311, 312 may be pulled, posteriorly, to seat the bone block310 on the glenoid 340.

Referring to FIGS. 3N and 3O, according to one or more aspects, each ofthe first suture loop 321 and the second suture loop 322 may bedisengaged from the guidewires 311, 312, respectively, and may beremoved from the body. As shown, a second cannula 302 may be disposedwithin the body, in addition to the first cannula 301, in the vicinityof the glenoid 340 and the bone block 310. According to one or moreaspects, the first locking member 323 and the first suture loop 321 maybe disengaged from the first guidewire 311 and removed from the bodythrough the second cannula 302. According to one or more aspects, agrasper (not shown), e.g., the grasper 360 shown in FIG. 3F, may bedisposed through the second cannula 302 used to remove the first lockingmember 323 and the first suture loop 321 from the body, while the secondlocking member 324 remains engaged with the bone block 310. As discussedabove, in one or more embodiments, in order to remove, or disengage, thefirst suture loop 321 from the first guidewire 311 a surgeon may pullthe first locking member 323 in a direction that is substantially awayfrom the first guidewire 311. Pulling the first locking member 323 in adirection that is substantially away from the first guidewire 311 maycause the first suture loop 321 to become unraveled, or becomeun-looped, and disengage from the first guidewire 311.

Once the first locking member 323 and the first suture loop 321 areremoved from the body, a needle guide wire 353 may be placed into thebody, e.g., into a proximal end 307 of the second cannula 302 and mayexit a distal end 308 of the second cannula 302, to create asubscapularis portal in-line with the holes of the bone graft 310, e.g.,holes 319A, 319B of the bone graft 310 shown in FIG. 3G. According toone or more aspects, once in the joint, a cannulated obturator (notshown) and a fixation cannula (not shown) may be inserted over theneedle guidewire 353. According to one or more aspects, tension may beapplied, posteriorly, on the second guidewire 312 in order to helpmaintain security of, e.g., engagement of, the bone block 310 againstthe glenoid 340, as the first guidewire 311 is removed, anteriorly,through the second cannula 302.

Referring to FIGS. 3P-3R, the sleeve (not shown), e.g., the sleeve 353aligned with the hole 349A of the glenoid 340 and engaged with theposterior side of the glenoid 340, may be removed to accommodateplacement of a first fixation screw 351. According to one or moreaspects, the first fixation screw 351 may be inserted into the proximalend 307 of the second cannula 302 and may be passed over the needleguidewire 353, through the second cannula 302, and may be driven intothe body by a drill or a screwdriver 334 until the first fixation screw351 is engaged with the bone block 310, and the bone block 310 issecured against the anterior side/edge 341 of the glenoid 340. Once thefirst fixation screw 351 is secured within the bone block 310 within thebody, the needle guidewire 353 may be removed from the body.

Subsequently, according to one or more aspects, the second lockingmember 324 and the second suture loop 322 may be removed from the bodythrough the first cannula 301 in the same fashion described above, withregard to the first locking member 323 and the first suture loop 321.According to one or more aspects, a second fixation screw 352 may beengaged with the bone block 310 such that the bone block 310 is securedagainst the glenoid 340 in the same fashion as described above, withregard to the first fixation screw 351. For example, the sleeve (notshown), e.g., sleeve 336 aligned with the hole 349B of the glenoid 340and engaged with the posterior side of the glenoid 340, may be removedto accommodate placement of the second fixation screw 352. Further, theneedle guidewire 353 may be disposed through the first cannula 302.Furthermore, according to one or more aspects, the second fixation screw352 may be passed over the needle guidewire 353, through the firstcannula 301, and may be driven into the body by a drill or a screwdriveruntil the second fixation screw 352 is engaged with the bone block 310,and the one block 310 is secured against the glenoid.

Those having ordinary skill in the art will appreciate that a manualscrewdriver, a powered drill, or any means of securing a screw into asurface may be used to secure the first fixation screw 351 and thesecond fixation screw 351 through the bone block 310 and into theglenoid 340. Further, according to one or more aspects, each of thefirst fixation screw and the second fixation screw 352 may be 34 mmcannulated screws. However, those having ordinary skill in the art willappreciate that fixation screws of any size that are adapted to be usedwith the bone block 310 may be used. Further, those having ordinaryskill in the art will appreciate that more or less than two guidewires,e.g., guidewires 311, 312, may be used. For example, in one or moreembodiments, one, three, four, or more guidewires may be used.

According to one or more aspects, bioabsorbable anchors may be placedaway from the trajectory of the fixation screws 351, 352 along theanterior edge of the glenoid 340, between the glenoid 340 and the boneblock 310. Further, according to one or more aspects, sutures may bepassed through a labrum and capsule and secured over a top, e.g., acortical surface, of the bone block 310.

A surgical kit, according to embodiments disclosed herein, may include afirst cannula having a hole formed therethrough and configured toreceive a bone block, a proximal end, a distal end, and a central axisdefined therethrough, a first guidewire, a second guidewire, a firstsuture loop comprising a first locking member, and a second suture loopcomprising a second locking member.

The kit may also include a glenoid guide having a hooked end, a secondcannula having a hole formed therethrough, a proximal end, and a distalend, a grasper, an obturator, a needle guidewire, at least one threadedscrew, wherein the at least one threaded screw is cannulated, and adrill configured to secure the at least one threaded screw into a bone.

Advantageously, embodiments disclosed herein may provide a surgicalassembly, method, and kit that may simplify and improve a technique fortreating anterior-inferior glenohumeral instability. As discussed above,pushing/pulling a bone block with graspers within the body and securingthe bone block with a suture may be difficult, and as a result,time-consuming, for a surgeon. The use of at least one threaded screw tosecure a bone block and the use of guide wires, suture loops, andlocking members to manipulate and secure the bone block within the bodymay help a surgeon in treating anterior-inferior glenohumeralinstability more quickly, precisely, and effectively.

In an alternate configuration, a surgical delivery apparatus includes asuture, and a locking component having a hole formed therethrough, inwhich the hole of the locking component is configured to receive thesuture. In one or more embodiments, the suture may be disposed throughthe hole formed in the locking component. In one or more embodiments,the suture may be formed into a closed loop. In one more embodiments, afirst knot and a second knot may be formed on the suture to form thesuture into the closed loop. In one or more embodiments, at least aportion of each of the first knot and the second knot formed on thesuture may be seated within the hole formed through the lockingcomponent.

Referring to FIG. 4A, a surgical delivery apparatus 800, in accordancewith embodiments disclosed herein, is shown. In one or more embodiments,the surgical delivery apparatus 800 may include a suture 801 and alocking component 802. In one or more embodiments, a hole 110 may beformed through the locking component 802, in which the hole 110 isconfigured to receive the suture 801. In one or more embodiments, thesuture 801 may be disposed through the hole 110 formed through thelocking component 802. In one or more embodiments, the locking component802 may be coupled to the suture 801.

In one or more embodiments, the suture 801 may be formed from anyflexible material known in the art, such as suture, polyester, plastic,a malleable metal, such as Nitinol, or any combination thereof. Further,as shown in FIG. 4A, the suture 801 may be formed into the closed loop.As used therein, the term “closed loop” may refer to any type of loopthat is formed by the suture. In one or more embodiments, the suture 801may be a closed, continuous loop. Alternatively, in one or moreembodiments, each of the suture 801 may be closed and may contain one ormore knots, e.g., first knot 107.

For example, in one or more embodiments, a first knot 107 and a secondknot (not shown) may be formed on the suture 801 to form the suture 801into a closed loop. Further, in one or more embodiments, movement of thelocking component 802 along the suture 801 may be restricted by both thefirst knot 107 and the second knot formed on the suture. For example, inone or more embodiments, a circumference of each of the first knot 107and the second knot may be larger than a diameter of the hole 100 formedthrough the locking component 8-2. Subsequently, in one or moreembodiments, each of the first knot 107 and the second knot may not beable to pass freely through the hole 100 formed through the lockingcomponent 802. As such, in one or more embodiments, the lockingcomponent 802 may not be able to pass freely over either the first knot107 or the second knot, which may restrict the movement of the lockingcomponent 802 along the suture 801. In one or more embodiments, at leasta portion of each of the first knot 107 and the second knot may beseated within the hole 110 formed through the locking component 802. Forexample, as shown in FIG. 4A, at least a portion of the first knot 107is seated, or disposed within, the hole 100 formed through the lockingcomponent 802.

As discussed above, in one or more embodiments, the locking component802 may be coupled to the suture 801. Those having ordinary skill in theart will appreciate that the locking component 802 by any means known inthe art. For example, the locking component 802 may be coupled to thesuture 801 by mechanical or chemical means, such as crimping, molding,or gluing. Alternatively, as discussed above, in one or moreembodiments, the locking component 802 may include the hole 110 formedtherethrough, in which the locking component 802 may be threaded ontothe suture 801, e.g., similar to a bead on a necklace. As shown, thelocking component 802 is substantially spherical in shape.

Those having ordinary skill in the art will appreciate that the shape ofthe locking component 802 may be any shape known in the art. Forexample, the shape of the locking component 802 may be spherical,hemi-spherical, cubic, prismatic, pyramidal, T-bar-shaped, cylindrical,elliptical, hexagonal, or any other shape known in the art.

Further, in one or more embodiments, the locking component 802 may beformed from any material known in the art. For example, in one or moreembodiments, the locking component 802 may be formed from metal,plastic, ceramic, or any other material known in the art. Alternatively,the locking component 802 may be formed from any biocompatible materialknown in the art. For example, in one or more embodiments, the lockingcomponent 802 may be formed from stainless steel.

According to another aspect, there may be provided a method for forminga closed loop for a surgical delivery apparatus, the method includingproviding a suture and a locking component, the locking component havinga hole formed therethrough and is configured to receive the suture,disposing a first end of the suture through the hole formed through thelocking component in a first direction, disposing a second end of thesuture through the hole formed through the locking component in a seconddirection that is opposite to the first direction, forming a first knoton the suture with the first end of the suture, and forming a secondknot on the suture with the second end of the suture.

The method may also include tightening the suture such that at least aportion of both the first knot and the second knot are seated within thehole formed through the locking component. The method may also includetrimming the first end of the suture on a region of the suture near thefirst knot, and trimming the second end of the suture on a region of thesuture on a region of the suture near the second knot. According to oneor more aspects, a trimming tool may be used to trim each of the firstend and the second end of the suture, such that fraying of the suturedoes not occur as a result of the trimming.

Referring to FIGS. 4B-4L, a method of forming a loop for surgicaldelivery apparatus 100, in accordance with embodiments disclosed herein,is shown. According to one or more aspects, the surgical deliveryapparatus 100 may include a suture 801, having a first end 1205 and asecond end 1206, and a locking component 8002. According to one or moreaspects, the locking component 802 may include a hole 210 formedtherethrough.

As shown in FIGS. 4A-4C the first end 205 of the suture 801 may bethreaded, or disposed, through the hole 1210 of the locking component802. According to one or more aspects, the first end 1205 of the suture801 may be threaded, or disposed, through the hole 210 of the lockingcomponent 802 in a first direction, such that the locking component 802is threaded onto the suture 801, e.g., similar to a bead on a necklace.

As shown in FIGS. 4D-4E, the second end 1206 of the suture 801 may bethreaded, or disposed, through the hole 1210 of the locking component802. According to one or more aspects, the second end 1206 of the suture801 may be threaded, or disposed, through the hole 1210 of the lockingcomponent 802 in a second direction that is opposite to the firstdirection, described above with respect to the first end 1205 of thesuture 801.

As shown in FIG. 4E, a first knot 1207 may be formed on the suture 801using the first end 1205 of the suture 801, and a second knot 1208 maybe formed on the suture 801 using the second end 1206 of the suture 801.According to one or more aspects, each of the first knot 1207 and thesecond knot 1208 may be overhand knots formed on the suture 801. Thosehaving ordinary skill in the art will appreciate that other types ofknots, other than an overhand knot, may be used to secure the first end1205 of the suture 801 and the second end 1206 of the suture 801 to thesuture 801. According to one or more aspects, 1-3 inches of the suture801 may remain, regarding the first end 1205 and the second 1206, oncethe first knot 1207 and the second knot 1208 have been tied. However,those having ordinary skill in the art will appreciate that, accordingto one or more aspects, more than 3 inches and less than 1 inch of thesuture 801 may remain, regarding the first end 1205 and the second end1206, once the first knot 1207 and the second 1208 have been tied.

As shown in FIGS. 4F-4G, each of the first knot 1207 and the second knot(not shown) may be tightened. As shown, segments of the suture 801 onopposite sides of the knot 1207 may be pulled in the directionsspecified by arrows 1230 and 1231, respectively, to tighten the knot1207. Those having ordinary skill in the art will appreciate thatsubstantially the same measures may be taken to tighten the second knot.

As shown in FIG. 4H, each of the first end 1205 and the second end (notshown) may be trimmed using a trimming tool, such that fraying does notoccur as a result of the trimming. As used herein, “fraying” may referto an area of the suture 801 whose ends split up and become unraveled ordistributed. Those having ordinary skill in the art will appreciate thatthe trimming tool may be any trimming tool known in the art. Forexample, according to one or more aspects, the trimming tool may bescissors, a knife, or any other object or tool with a sharp edge capableof severing, cutting, or trimming the suture 801. According to one ormore aspects, the heated knife may be used as the trimming tool.According to one or more aspects, the heated knife may both sever, ortrim, the suture 801 and may also close, e.g., melt, the trimmed areasof the suture 801 to prevent fraying. According to one or more aspects,1 mm-3 mm of the suture 801 may remain of each of the first end 1205 andthe second end 1206 after each end is trimmed. However, those havingordinary skill in the art will appreciate that more than 3 mm and lessthan 1 mm of the suture 801 may be left after each of the first end 1205and the second end 1206 of the suture 801 is trimmed.

As shown in FIGS. 4I-4L, the suture 801 may be tightened, or tensioned,such that at least a portion of both the first knot 1207 and the secondknot 1208 are seated, or disposed, within the hole formed through thelocking component 802. As shown in FIG. 2L, segments of the suture 801may be pulled, or tensioned, in the directions specified by arrows 1232and 1233 to displace each of the first knot 1207 and the second knot1208 toward the locking component 802. Further, as shown in FIGS. 2M-2N,segments of the suture 801 may be further pulled, or tensioned, in thedirections specified by arrows 1234 and 1235 to further displace each ofthe first knot 1207 and the second knot 1208 toward the lockingcomponent 802. According to one or more aspects, the segments of thesuture 801, discussed above, may be on either side of the lockingcomponent 802. According to one or more aspects, a first segment of thesuture 801 may be pulled in the direction of arrow 1234 and a secondsegment of the suture 801, which is on an opposite side of the lockingcomponent 802 from the first segment, may be pulled in the direction ofarrow 1235, which may cause tension on the suture 801.

Advantageously, embodiments disclosed herein may provide a surgicaldelivery apparatus and a method of forming a loop for a surgicaldelivery apparatus that may simplify and improve a technique fortreating anterior-inferior glenohumeral instability. As discussed above,forming a first knot and a second knot on opposite sides of a lockingcomponent may restrict movement of the locking component along a suture.Restricting this type of movement on the suture may help duringinstallation and retrieval of the surgical delivery device by a surgeonin treating anterior-inferior glenohumeral instability more quickly,precisely, and effectively.

FIGS. 5A-5D show an alternate configuration having a suture loop 801with a locking ball 802, similar to the locking component 124 shown inFIGS. 3A-3R. FIGS. 5A-5D depict bone graft mounting using the lockingball 802 arrangement of FIGS. 4A-4L. Referring to FIGS. 1 and 5A-5D thefirst guidewire 211 engages a suture 801 having a placement object 802,such as a locking component 124. The locking 802 has a bore 1210extending therethrough at a width adapted for receiving a plurality ofsutures. The suture 801 has a first end 1205 and a second end 1206 bathpassed through the bore 1210 in the placement object 802. The opposedends 1205, 1206 are tied in respective knots 1207, 1208 on the suture801 to form a continuous loop. The ends 1205 and 1206 may be trimmedbeyond the knots 1207, 1208 to any suitable length. The suture 801 isthen drawn to slideably dispose the knots 1207, 1208 toward theplacement object 802 such that the knots 1207, 1208 are concealed incounterbores 1251, 1250, respectively. The knots 1207, 2309 are of adiameter that they cannot pass beyond the counterbore 1251, 1250 intothe bore 1210, and therefore prevent sliding of the placement object 802and allow manipulation of the placement object 802 via tension on thesuture 801. The placement object 802 therefore engages the first orsecond guidewire 211, 212 as above for facilitating bone graft 110placement while permitting tensioned control from the suture 801.

In the example configuration and procedure depicted in FIGS. 5A-5D, thebone graft placement device 800 includes a placement object 802 havingan exterior surface, such that the exterior surface is adapted forengaging a bone graft 210 and distributing forces across a surface ofthe bone graft 210 for disposing the bone graft 210 into alignment witha receptive surgical site 340. An aperture through the exterior surfacedefines a bone 1210 receptive to the suture 801 for securing the suture801 for drawing the placement object 802 against the bone graft 210 fordisposing the bone graft 210 to the surgical site. In the examplearrangement, the placement object 802 is spherical and the aperture isdefined by the bore 1210 though the sphere and adapted to pass at leastone suture through the bore, such that the bore 1210 defines an apertureon both sides of the placement device in which the suture 801 emanatesfrom both apertures.

In operation, the method of placing the surgical bone graft 210 includesengaging the bone graft 210 with the placement object 802, such that theplacement object 802 disposes the bone graft 210 into alignment withpredrilled apertures 349A, 349B by evenly distributing forces on thebone graft 210. The placement object 802 disposes the bone graft 210from an external tethered linkage provided by the guide wire 211, suchthat the tethered linkage secures the placement object 802 and isresponsive to tension forces external to the arthroscopic surgical sitedue to the tethered linkage engaging a suture strand 801 passing throughthe placement object 802. Tension or pulling on the guidewire 211therefore guides the bone graft 210 to a predetermined position at thesurgical site by disposing the bone graft 210 via the tether, due to thetether passing through an engagement surface 340 receptive to the bonegraft. A plurality of guide holes on the engagement surface may beemployed, such that each of the plurality of guide holes corresponds toa hole on the bone graft, each of the corresponding pairs of holes forreceiving the threaded tether for guiding a respective placement object.

Proper preparation includes forming the bone 1210 through the placementobject 802, and forming a continuous suture loop 801 passed through thebore 1210 in the placement object 802. The formed bore 1210 has a widthof at least two sutures, as the continuous suture loop 801 is formedpassing a plurality of suture strands 801 through the bore, one end ineach direction, and engaging the passed strand with an adjacent strandof the passed plurality of strands. Preparation includes passing theopposed ends 1205, 1206 of the suture strand 801 through the bore 1210,in which the opposed strands enter the bore from opposed ends such thatthe passed strands form a loop closed by adjacent strands passing in thebore. In the example arrangement, both ends 1205 and 1206 of the suturestrand 801 are inserted into opposite ends (apertures) of the bore 1201,passing in opposite directions and emerging on the opposed sides. Theloop 801 is closed by attaching each end of the opposed strands to theadjacent strand upon exiting the bore by knots 1207, 1208.

In a particular arrangement, this includes inserting first and secondends 1205, 1206 of a suture strand 801 through opposed ends of the bore1210, in which each inserted end defines a trailing suture segment andpassing the other of the first 1205 and second ends 1206 within the bore1210. The suture slideably engages each of the first 1205 and secondends 1206 with the trailing suture segment of the other of the first andsecond end by knotting the end to the trailing suture segment, such thatthe knot 1207, 1208 is adapted to slide along the trailing suturesegment to the bore 1210 for drawing the suture down to knot 1207, 1208.Counterbores 1250, 1251 conceal the knots 1207, 1208 flush with theexternal surface of the placement object 802 and fix the suture 801 asthe knot is larger than the bore 1210 beyond the recess of thecounterbore 1250, 1251.

The surgical procedure may further include identifying the engagementsurface on a skeletal member of a patient, drilling a plurality of guideholes 349A, 349B through the engagement surface, and threading a tethersuch as the guide wire 311 through each of the guide holes 349A, 349B. Asurgeon then positions a placement tube to define the predrilledapertures, and passes the tether through the placement tubes, thepredrilled apertures and the aperture in the placement object 802.

In the example arrangement, the surgical delivery apparatus 800 includesa suture 802, and a locking component such as the placement object 802having a hole formed therethrough such as bore 1210. In keeping with thesurgical nature, the locking component is substantially spherical inshape and comprises a biocompatible material. The hole of the lockingcomponent is configured to receive the suture 801, responsive to thesuture 801 being disposed through the hole formed through the lockingcomponent and formed into a closed loop. A first knot and a second knotare formed on the suture to form the suture into the closed loop, andmovement of the locking component along the suture 801 is restricted byboth the first knot and the second knot formed on the suture. At least aportion of each of the knot 1207 and the second knot 1208 formed on thesuture are seated within the hole 1210 formed through the lockingcomponent.

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the spirit and scope of the presentapplication as defined by the appended claims. Such variations areintended to be covered by the scope of this present application. Assuch, the foregoing description of embodiments of the presentapplication is not intended to be limiting, the full scope rather beingconveyed by the appended claims.

What is claimed is:
 1. A surgical delivery apparatus comprising: asuture; and a locking component having a hole formed therethrough,wherein the hole of the locking component is configured to receive thesuture, and wherein the suture is disposed through the hole formedthrough the locking component and formed into a closed loop whichextends a distance away from and loops back to the locking component. 2.The apparatus of claim 1, wherein a first knot and a second knot areformed on the suture to form the suture into the closed loop.
 3. Theapparatus of claim 2, wherein movement of the locking component alongthe suture is restricted by both the first knot and the second knotformed on the suture.
 4. The apparatus of claim 3, wherein at least aportion of each of the first knot and the second knot formed on thesuture are seated within the hole formed through the locking component.5. The apparatus of claim 1, wherein the locking component issubstantially spherical in shape and comprises a biocompatible material.6. The apparatus of claim 1, wherein an end of the closed loop distalfrom the locking component is threaded through a receiving guidewireloop and then back through itself to join the surgical delivery devicewith the guidewire, whereby the locking component is positioned at theintersection point between the receiving suture loop and the closed loopof the surgical delivery apparatus.
 7. The apparatus of claim 1, whereinthe closed loop is formed by threading a first end of the suture throughthe hole in the locking component in a first direction and a second endof the suture through the hole in the locking component in a secondopposite direction and knotting the first and second threaded ends tothe closed loop on respective sides of the locking component.
 8. Theapparatus of claim 7, wherein the forming of the closed loop furtherincludes trimming the ends of the suture after the knotting thereof. 9.The apparatus of claim 7, wherein the forming of the closed loop furtherincludes pulling the loop taut such that the knots are seated ordisposed, within the hole.
 10. The apparatus of claim 9, whereinmovement of the locking component along the suture is restricted by theknots.
 11. The apparatus of claim 1, wherein the closed loop extendsaway from a first end of the hole in the locking mechanism and loopsback around to a second opposite end of the hole in the lockingmechanism.
 12. A bone graft placement device comprising: a placementobject having an exterior surface, the exterior surface adapted forengaging a bone graft and distributing forces across a surface of thebone graft for disposing the bone graft into alignment with a receptivesurgical site; and an aperture through the exterior surface, theaperture defining a bore receptive to a suture for securing the suturefor drawing the placement object against the bone graft for disposingthe bone graft to the surgical site.
 13. The device of claim 12 whereinplacement object is spherical and the aperture is a bore through thesphere and adapted to pass at least one suture through the bore, thebore defining an aperture on both sides of the placement device suchthat the suture emanates from both apertures.
 14. The device of claim 12wherein the placement object is a spherical shape having a central borefor receiving at least one suture strand.
 15. A method of placing asurgical bone graft comprising: engaging a bone graft with a placementobject, the placement object disposing the bone graft into alignmentwith predrilled apertures by evenly distributing forces on the bonegraft; disposing the bone graft from an external tethered linkage, thetethered linkage securing the placement object and responsive to tensionforces external to an arthroscopic surgical site, the tethered linkageengaging a suture strand passing through the placement object; andguiding the bone graft to a predetermined position by disposing the bonegraft via the tether, the tether passing through an engagement surfacereceptive to the bone graft.
 16. The method of claim 15 furthercomprising: forming a bore through the placement object; and forming acontinuous suture loop passed through a bore in the placement object.17. The method of claim 16 wherein the formed bone has a width of atleast two sutures, the continuous suture loop formed by: passing aplurality of suture strands through the bore; and engaging the passedstrand with an adjacent strand of the passed plurality of strands. 18.The method of claim 16 further comprising forming the continuous sutureloop by: passing opposed ends of a suture strand through the bore, theopposed strands entering the bore from opposed ends such that the passedstrands form a loop closed by adjacent strands passing in the bore; andattaching each end of the opposed strands to the adjacent strand uponexiting the bore.
 19. The method of claim 5 further comprising:inserting first and second ends of a suture strand through opposed endsof the bore, each inserted end defining a trailing suture segment andpassing the other of the first and second ends within the bore;slideably engaging each of the first and second ends with the trailingsuture segment of the other of the first and second end by knotting theend to the trailing suture segment, the knot adapted to slide along thetrailing suture segment to the bore.
 20. The method of claim 15 furthercomprising: identifying the engagement surface on a skeletal member of apatient, drilling a plurality of guide holes through the engagementsurface, threading a tether thought each of the guide holes.
 21. Themethod of claim 20 further comprising: positioning a placement tube todefine the predrilled apertures; and passing the tether through theplacement tubs, the predrilled apertures and the aperture in theplacement object.
 22. The method of claim 20 wherein each of theplurality of guide holes corresponds to a hole on the bone graft, eachof the corresponding pairs of holes for receiving the threaded tetherfor guiding a respective placement object.
 23. A method of forming aclosed loop for a surgical delivery apparatus, the method comprising:providing a suture and a locking component, the locking component havinga hole formed therethrough and is configured to receive the suture;disposing a first end of the suture through the hole formed through thelocking component in a first direction; disposing a second end of thesuture through the hole formed through the locking component in a seconddirection that is opposite to the first direction; forming a first knoton the suture with the first end of the suture; and forming a secondknot on the suture with the second end of the suture.
 24. The method ofclaim 23, further comprising: tightening the suture such that at least aportion of both the first knot and the second knot are seated within thehole formed through the locking computer.
 25. The method of claim 23,further comprising: trimming the first end of the suture on a region ofthe suture near the first knot; and trimming the second end of thesuture on a region of the suture near the second knot.
 26. The method ofclaim 25, wherein a trimming tool is used to trim each of the first endand the second end of the suture such that fraying of the suture doesnot occur as a result of the trimming.
 27. The method of claim 12,wherein the locking component is substantially spherical in shape andcomprises a biocompatible material.
 28. A bone graft surgical kit,comprising: a cannula having a hole formed therein; a bone graft havinga first hole and a second hole formed therethrough, said bone graftdimensioned to fit into said hole in said cannula; a first lockingmember having a first hole formed therethrough; a second locking memberhaving a second hold formed therethrough; a first suture loop passingthrough said first hole in said first locking member; a second sutureloop passing through said second hole in said second locking member; afirst guidewire extending through said hole in said cannula and firsthole of said bone graft and being engaged with said first suture loop; asecond guidewire extending through said hole in said cannula and saidsecond hole of said bone graft and being engaged with said second sutureloop; a first placement object having an exterior surface, said exteriorsurface of said first placement device being shaped for engaging saidbone graft and for distributing forces across said exterior surface ofsaid bone graft to dispose said bone graft into alignment with areceptive surgical site; and a second placement object having anexterior surface, said exterior surface of said second placement objectbeing shaped for engaging said bone graft and for distributing forcesacross said exterior surface of said bone graft to dispose said bonegraft into alignment with a receptive surgical site; wherein said firsthole in said bone graft is dimensioned to receive said first guidewireand said second hole in said bone graft is dimensioned to receive saidsecond guidewire.
 29. The bone graft surgical kit of claim 28, whereinsaid first and second placement objects are spherical.
 30. The bonegraft surgical kit of claim 28, wherein said first and second placementobjects are larger than said first and said second holes in said bonegraft, respectively.
 31. The bone graft surgical kit of claim 28,wherein said first suture loop is knotted.
 32. The bone graft surgicalkit of claim 28, wherein said exterior surface of said bone graft isshaped to engage an anterior surface of a glenoid.